TISSUE PREFABRICATION OF COMBINED SCAPULA FLAPS FOR MICROSURGICAL RECONSTRUCTION IN ORO-MAXILLOFACIAL DEFECTS

A NEW METHOD

Vinzenz K^1,2,3, Holle J², Würinger E², Kulenkampff KJ⁴

¹ Dept. for Maxillofacial Surgery, Evangelisches Krankenhaus Wien-Währing (Head: Prim.Univ.-Prof. Dr.K. Vinzenz); ² Dept. for Plastic and Reconstructive Surgery, Wilhelminenspital (Head: Prim.Univ.-Prof. Dr. J. Holle); ³ Institute for Oral and Maxillofacial Surgery, Krankenhaus Lainz (Head: Prim. MR. Dr. R. Fischer); ⁴ Central Institute for Radiology, Krankenhaus Lainz (Head: Prim.Univ.-Prof. Dr. H. Czembirek)

Principal author:

Associate Professor Kurt Vinzenz, M.D., D.D.S.
Dept. for Maxillofacial Surgery
Evangelisches Krankenhaus Wien-Währing
Hans Sachs-Gasse 10-12
A-1180 Vienna
Tel.: +43/1/40422-0, Fax.: +43/1/40565059, Email: kurt.vinzenz@vienna.at

SUMMARY

Nowadays, in congenital or aquired large oro-maxillo-facial defects microsurgical reconstruction is mainly performed by revascularized osseous, osteocutaneous, or osteomyocutaneous distant flaps.

The aims of reconstruction include not only restoration of stable continuity and esthetic contour, but also the restoration of a functioning "chewing organ". Beside the bulkyness of flaps, the stepwise surgical procedure (microvascular reconstruction, osseointegration of implants, secondary correction of flaps including preprosthetic surgery, etc.) is preventing physiological oral function for a long time, and gives some implications for creating an alterative method of microsurgical reconstruction with new designed flaps.

For reconstruction in maxillary and midface defects we preferably use the scapula flap.

Since modern diagnostic methods allow a comprehensive planning defining all relevant anatomical and functional factors in advance, now the "at one time " microvascular reconstruction by prefabricated scapula flaps becomes possible and offers some advantages:

The tissue prefabrication results in osseointegrated implants and and thin mucosal linings with stable periimplantory soft tissue conditiones at time of microsurgical reconstruction.

Postoperatively after immediate dental restoration full oral function is given.

The "at one time" reconstruction improves the psychosocial situation of the patient considerably.